Real Talk Book Request Form

Your Contact Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Organization / School / Program Name
Your Role / Title
Examples: teacher, school counselor, youth worker, program director, mentor, pastor, librarian
City and State
Tell Us About Your Students
What age or grade level do you primarily work with?

Other
About how many students do you serve each year?
Briefly tell us about the students, school, or community you serve.
Book Request
What type of request are you submitting?
If you are requesting student copies, how many copies would you like?
How do you plan to use the book with students?

Other
Amazon Review
To help boost public awareness and sales of Real Talk Before High School, we ask that our readers and community partners post an honest book review on Amazon.
Will you consider posting an honest review after receiving your free review copy?
Please upload a screenshot of your Amazon review.

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Mailing Information
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this a school, organization, or home address?

Other
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is there anything we should know about mailing or delivery?
Additional Comments:
Anything else you would like us to know?
Should be Empty:

Your Contact Information